Atypical Polypoid Adenomyoma of the Vagina: Follow Up and Subsequent Evolution: A Case Report and Update

Abstract

Atypical polypoid adenomyoma (APA) is a rare tumor developed from a mix of cells of epithelial and mesenchymal origin. We present the case of an 84-year-old patient with atypical polypoid adenomyoma on the vaginal vault, after total hysterectomy with total adnexectomy for endometrial hyperplasia with atypia four years ago. Not following regular indicated gynecological appointments, the symptoms presented were vaginal bleeding and anemia. The importance of the case consists both in the unique way in which the adenomyoma appears on the vaginal vault and in the subsequent evolution of this pathology. After complete resection, it recurs in five months with a malignant transformation into carcinosarcoma. This fact shows that adenomas can turn not only into carcinomas but also the mesenchymal component can progress to sarcoma, a fact of exceptional rarity. Follow-up and accurate diagnosis are essential for proper management, which is a challenge anyway due to the lack of case studies.

Retrospective Study on the Incidence of Benign, Premalignant, and Malignant Gynecologic Disorders in Patients with Adenomyosis: Analysis of 5648 Specimens

“…It serves as an indicator or precursor of endometrial adenocarcinoma or may coexist with endometrial adenocarcinoma (40,41). Literature data indicate that APA is an endometrial tumor with low malignant potential and low incidence, more commonly affecting patients of childbearing age (42). Among 237 patients included in eleven retrospective studies, 85.5% were premenopausal, and 62.9% were nulliparous.…”

“…The overall risk of recurrence and progression to cancer was reported to be 28.9% and 16.6%, respectively (43). Numerous studies have linked the pathogenesis of APA with estrogen-related factors, obesity, diabetes, long-term estrogen stimulation, and hormone replacement therapy (HRT) (42). Due to the rarity of APA, there have been no retrospective studies with large sample sizes, and the exact pathogenesis of APA remains unclear.…”